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Lung cancer


The symptoms of lung cancer depend on the location and size of the primary tumour, and the location of possible metastases. The most common symptoms include:
- persistent, therapy-resistant cough,
- weight loss,
- coughing up blood,
- chest pain,
- shortness of breath,
- neurological symptoms related to brain metastases (epilepsy, morning headaches, visual and speech disturbances, balance problems),
- symptoms related to bone metastases (acute and persistent bone pain),
- other symptoms related to metastases to other organs.

The main cause of lung cancer is smoking. It has been proven that smoking 20 cigarettes per day increases the risk of developing lung cancer between 20 and 25 times. Passive smoking, e.g., living with a smoker, causes approximately a third of all lung cancer cases. Overall, carcinogenic substances in tobacco smoke are responsible for 90% of total lung cancer cases.

Other known risk factors include exposure to asbestos, uranium, and other environmental carcinogens, as well as family history of lung cancer.

So far, a uniform and effective secondary preventive strategy has not been implemented anywhere in the world: administering routine chest X-rays turned out to be ineffectual – it does not improve the prognosis for the patients who were asymptomatic at diagnosis.

There are high hopes for administering routine, low-dose CT scans of the chest to those in the high-risk group (particularly to long-time smokers). However, this measure is estimated to lower the lung cancer mortality rate only by 20%; what is more, it is not refunded in Poland.

The basis of effective preventive medicine in lung cancer is primary preventive care, i.e., not smoking, as tobacco smoke is highly carcinogenic.

The key prognostic factor is the stage of the cancer (on I-IV scale); therefore, determining it is the first step in the diagnostic and therapeutic process. The tests used to do that include: CT scan of the chest, bronchoscopy, scans that allow assessment of the remote organs that are the most common sites for metastases, and other tests deemed necessary in individual cases.

The treatment is planned according to the spread and histological type of the cancer. During bronchoscopy, a biopsy of suspicious lesions is performed, and the biopsy material is submitted for histopathology. A pathomorphologist ascertains whether the lesion is a lung cancer, then determines its malignancy level (grades G1-G4) and type. The most common types are three non-small cell lung cancers: adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, and small cell lung cancer.

The course of treatment is decided on the basis of all this information. The best outcome is when the patient qualifies for surgery, during which the whole or a part of a lung is removed together with the regional lymph nodes. The chances of full recovery can be increased for many patients with post-surgery treatment involving chemotherapy, radiotherapy, or both.

However, some patients are not eligible for either surgery or conservative treatment (chemotherapy, radiotherapy) because of a coexisting condition, such as cardiovascular disease, neurological disorders, kidney disease, respiratory disease, etc. What is more, a considerable number of the patients who underwent surgery experience a relapse within 2 years, which is usually non-operable. Such patients, apart from oncological treatment meant to lengthen their lifespans and improve the quality of live, receive also intensive palliative care focused on relieving pain, shortness of breath, depression, and other symptoms related to the progression of the disease.

In some patients, mutations of certain genes (e.g., ALK, EGFR) are discovered, making them eligible for a targeted therapy. Such therapy does not lead to full recovery but its results are better than those of the “classic” chemotherapy.

With a malignant cancer as fatal as lung cancer the biggest hope lies in clinical trials, during which new drugs and potentially effective diagnostic-therapeutic methods are tested in a way that is safe for the patients.


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